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- Mr FOR OFFICE USE APPLICATION FOR SANITATION PERMIT - -'--- - --------------------------- Permit No. ---73��la ---------- M (Complete in Triplicate} ----------- ------------------------------- } aZ/�73 w a - Date Issued ._,O 1This,PermitExpires 1 Year'From_DateIssued Application is hereby made to the San Joaquin Local Health Districtifor 65-'permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - -- � JOB ADDRESS/LOCATION ._ _ __ __ZZAJ -- -- -- - -- ----- -------------CENSUS TRACT __ Owner's Name ----- ---q �- � City --- J 6 N E -------- _ -------------Phone �----------•----- Address - k /1 ---- ----- `=Q/1��-r 11' {}L � -g r Contractor's Name ± E= -- License # Phone Installation will serve. Residence partment House❑ Commercial ❑Trailer Court ;❑ Motel --Other ---------------------------1�--------------•-VV Number of living units:_________ Number of bedrooms 2-----.Garbage GrinderLot Size .....---- Water Supply: Public System and name ---------------------------------- ----------------------------------------- ---------------------------------Private Character of soil to a depth of 3 feet: Sarid E❑ Si t❑ Clay ❑'' Peat Sandy Loam ❑ Clay Loam P__� Hardpan Adobe ❑ Fill Material ____ If yes,type ----------------------- (Plot plan, showing size of lot, location of system i t' lotion to wells, buildings, etc. must be placed on reverse side.) p p p' p public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' Sie_____ _ NEW INSTALLATION: (No septic tank or see a it `ermined if v [ ] ,�, r ��_ _�_!(�__X_�^ Liquid Depth --- p---------------- /No. ❑city _!_�'-..___ Type -{��'FCR�Material-a_A&ice No. Compartments __�.—__--_. � ance to nearest: Well -_ ____________________Foundation _A0__�`___ Prop. Line ____ ___......______ LEACHING LINE of Lines ---- ---------- Length of each line-___5---- �,�+ Len ----____-- Total Length __1-��-----r....-_ 00� D' Boxy Type Filter Nlaterial C�K;'Depth -Filter Material -------�__[____��__________________ _____ V r Distance to nearest: Well ---_-'--- -`Foundation --- Property Property Line __ '_ ._.__. 00 SEEPAGE PIT Depth �_- .._____ Diame'ter�._X _ Number.___ -- ---___ Rock Filled Yes a ❑ Water Table Depth _-_ ' - __ Rock Size _ .- / m r . . - .- - 1------------ ---- ., Distance to nearest: Well _� � _-��__________-Foundation ------- Prop.Prop. Line ____. - �- z REPAIR/ADDITION{Prey. Sanitation Permit# ---------------------------------------- -- Date ________________-`-._ ._,______) k.. Z Septic Tank (Specify Req"uirements) - ------ -- --- ----------------------------'-------- ---- -'------------------------------------------------- -- ----------------- Disposal Field-(Specify ,Requirements) ----------------------------- --- -------------------------------------- -`--------------------------------- - ------ ' ---------------------------------------------------------------- - --lo ----- -------------------------------- ------------------------------------------- -------------------- ---- ----- (Drw existing and required addition on reverse side) I hereby certify'thbt 1 have prepared this application and that the work will be done in accordance-with San Joaquin County Ordinances, State-taws, and Rules and Regulations of the San Joaquin Local Health District. Home,owner or licen- sed agentspdatu re certifies the following:"I certifth perform n e of the work for which this permit is issued, I shalt not employ any person in such manner as to b coj tto Wo an's Compensation laws of California."Signed ----- -- -- ---- ------------- ----------------------------- Owner .* By --------------------------- ( C Q Title ------------------- ---- ---------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED' BY ---- ----------------------------------------------------------- ------- ---- DATE --- BUILDING PERMIT ISSUED --------- - ---------- ----------------------DATE ------------ ------------- ----------- -- ADDITIONAL COMMENTS - -«--. - •--------------------------. ... ._. .--•---=-:--------•---------------- - ------------- _ ------------- ---------------------------------------------------- -------- ---- --------------------- , -- --- ---- ---- ---- -- -- ------- -------- _ _ _ - - -- ---------------------- -------------- �' f ---- ----•------------------ -------- x _ W - ---. Date ---•- ------------- -- --------- Finallnspectio ---- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M